When you become eligible for Medicare, you can better anticipate your future medical needs knowing you have coverage. However, Original Medicare might not cover all of your costs. Many people ask, how does this
affect my prescription drug coverage?
Medicare’s payment structure for prescription drugs is sometimes hard to understand. If you only have Original Medicare, you might not have any coverage for your standard prescription costs. Therefore, you might need additional Medicare Part D coverage.
What’s Original Medicare?
Original Medicare is the w health insurance offered by the U.S. government. Most people get this coverage when they turn 65. It consists of Medicare Part A and Medicare Part B.
- Part A coverage will pay for inpatient hospital costs, such as surgeries and diagnostic services provided during an admission.
- Part B coverage will pay for your outpatient costs, like the costs of your physician visits, routine lab testing, vaccines and more.
However, only in limited cases will your Original Medicare pay for your medication costs. Should you receive medication treatments during a hospital admission then your coverage might pay. However, if you try to use your Original Medicare for your standard prescription costs, then you will likely find that you have no assistance.
Medicare Part D Prescription Coverage
From 2011 to 2014, 48% of Americans took at least one prescription drug each month. Roughly 11% of people took three or more. That resulted in billions of dollars in out-of-pocket costs for Americans each year. However, if you have health insurance, then your coverage will help you minimize the costs of your personal prescription costs.
All the same, if you want this coverage through the Medicare program, then you will likely have to buy a Medicare Part D prescription drug plan. Part D plans are supplement plans to Original Medicare offered by private insurers. They will pay for some or all of the cost of your prescription drugs. Indeed, you might pay as low as $5 prescription, depending on your plan.
Like with most non-Medicare prescription insurance, Part D plans have formularies, and many separate drugs into tiers
- A formulary is the official list of the medications a plan will cover. The formularies can change from year to year, and will include numerous drugs, both generic and brand-name. Formularies might vary from plan to plan.
- Within the formulary will exist tiers, usually numbered 1 – 4. Different drugs will fall into different tiers, and how they do so might vary. Usually, Tier 1 drugs are the cheapest, while Tier 4 drugs are the most-expensive or most-unique.
There are a lot of Part D plans on the market, and each will vary. However, they all must meet certain regulations set by Medicare law. Therefore, if you want to get a plan, talk to one of our agents. We can help you determine the appropriate plan for your prescription needs.